The Mad Among Us<\/a>\u201d (New York: The Free Press, 1994) (but only recently acquired by our local public library and discovered by me, I found this to be disturbing: I was trained in the thick of it, almost, at the mid-end of the psychoanalytic phase, so there are vague roots of allegiance that are being stretched. (This is not logical, but emotional.)<\/p>\nYet I have done a goodly amount of reading in the history of psychiatry as well as thought about the various types of patients I\u2019ve seen. It seems to me that the controversy involves not two but three to five (at least) sub-populations.<\/p>\n
To begin with, I think there\u2019s still a widespread sentiment among non-medical psychotherapists that all kinds of mental illness can be significantly treated without medicines. I confess that what we have today in the way of medical treatments is far from optimal\u2014many have undesirable side effects. It\u2019s just that on the whole they\u2019re much better than a generation ago, and even those a generation ago were much better than the era when no medicines helped very much. But the point is that psychotherapy in my opinion is variably helpful for the more seriously mentally disordered. (Part of the problem is that many of these people suffer from anosognosia, a deep kind of denial, and so they are inclined to not take their medicine when left alone.)<\/p>\n
On the other hand there are a good many conditions that perhaps should not be prescribed medication. This may vary with the patient, who\u2019s complaining, how much they\u2019re complaining, and so forth. I would prefer that physicians (who prescribe far more psychotropic medicines than psychiatrists) would be more cautious about resorting to medical treatments and work more closely with local psychotherapists to treat these problems through talk-action therapy. (I mean by action the use of certain role playing techniques.)<\/p>\n
For many patients of all types there are very real issues of attitudes, over-learning of certain beliefs, the lack of exposure to other sources that would promote resilience, and these formulations, un-learnings and new learnings need to happen to effect true change and not just variations of numbing-out. While not core to the treatment of the major psychoses, addressing these kinds of themes plays an important role in helping to prevent relapse. <\/p>\n
Mixed Categories<\/strong><\/p>\nA number of psychiatric disorders are the result of behaviors that change the functioning of the brain somewhat, but these changes derive mainly from the dynamics of trauma or addiction\u2014a mixture of habit-building, anxiety avoidance, narrow repertoire, and often one feeds the other. That is to say, some drug or alcohol or sexual addictions mask the anxiety developed in the course of living with trauma or secondary to the behaviors associated with the addiction. In turn, as hinted above, addiction leads sometimes to negative behavior, fights, and further trauma. So vicious cycles of mutual reinforcement are common parts of both PTSD and addiction.<\/p>\n
There are scores of near-addictions, subtle addictions, problem-causing habituations, that affect health as well as life-style. Lately, obesity and its associated metabolic disorders such as secondary diabetes is being looked at as an addiction to junk food. So all of these may overlap with and compound other behavioral syndromes.<\/p>\n
These in-between types are mixtures of psycho-social disorders and primary or secondary neuro-physiological changes. Both physical and psychological interventions are needed.<\/p>\n
Related to all these are those who have various extremes or variants of temperament and abilities (or disabilities) and yet they\u2019ve not been able to adjust their lives to these qualities of individuality. Rather, they\u2019ve tried to adjust themselves to the average socio-cultural sets of demands, and it doesn\u2019t work. These, too, need a combination of physical adjustment or medicines and education for living realistically with their temperament and abilities.<\/p>\n
Grob\u2019s book addresses the politics of the care of people who tended to be more chronically and severely disturbed\u2014especially with schizophrenia or debilitating manic-depressive illness. The senile, the severely mentally retarded, the severely retarded, those, in short, with problems that need a lot of care, should not be lumped theoretically, psychologically, with those who can work and afford to attend and pay for psychotherapy sessions. But let\u2019s not forget the intermediate forms\u2014people who tend to be diagnosed as healthier than they are, or who tend(ed) to be imagined to be more fixed and \u201csicker\u201d than they actually were. So it requires careful diagnosis in a field in which the issues as well as implications associated with the diagnostic process is murky. <\/p>\n
In summary, then, it\u2019s critically important to identify the unique nature of people\u2019s problems. Merely identifying diagnostic categories is as weak as treating people according to height or weight. A much finer system of discrimination is needed. This of course relates to the realistic near-impossibility of assessing treatments for broad categories of people (based, for example, on general diagnosis). Some are more intrinsically motivated, resilient, have more to offer than others, and this also speaks to their social surroundings. The desire for simplicity needs to be confronted.<\/p>\n","protected":false},"excerpt":{"rendered":"
Things have changed: Different types of \u201cmental illness\u201d need to be discerned. Certainly the history of medicine includes as a them the recognition that, for example, some diseases that seemed to be infectious were actually due to nutritional deficiency\u2014such as pellagra. Similarly, a number of major mental illnesses such as \u201cdementia paralytica\u201d that was a […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22,19,12],"tags":[],"class_list":["post-770","post","type-post","status-publish","format-standard","hentry","category-book-reviews","category-events","category-psychotherapy"],"_links":{"self":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts\/770"}],"collection":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=770"}],"version-history":[{"count":1,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts\/770\/revisions"}],"predecessor-version":[{"id":771,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts\/770\/revisions\/771"}],"wp:attachment":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=770"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=770"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=770"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}